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Part 40

The symptoms of subluxations and luxations, and where, and how, and
how much these differ from one another. And the cases in which the
articular cavity has been broke off, and in which the ligament has
been torn, and in which the epiphysis has broken in which, and how,
when the limb consists of two bones, one or both are broken: in consequence
of these the dangers, chances in which bad, and when the injuries
will result in death, and when in recovery. What cases are to be reduced
or attempted, and when, and which, and when not; the hopes and dangers
in these cases. Which and when congenital dislocations are to be undertaken:
the parts in a state of growth, the parts fully grown, and why sooner,
or slower: and why a part becomes maimed, and how, and how not: and
why a certain part is atrophied, and where, and how, and in what cases
to a less extent. And why fractured parts unite sooner or slower,
how distortions and callosities form, and the remedy for them. In
what cases there are external wounds, either at first or afterwards:
in what fractures the bones are shortened, and in what not: in what
cases the fractured bones protrude, and when they protrude most: in
what cases dislocated bones protrude. That physicians are deceived,
and by what means, in what they see, and in what they devise, regarding
affections, and regarding cures. Established rules with regard to
bandaging:[p. 297] preparation, presentation of the part, extension, adjustment,
friction, bandaging, suspension and placing of the limb, attitude,
seasons, diet. The more porous parts heal fastest, and vice versa.
Distortions, where the bones are crooked. Flesh and tendons wasted
on the side of the dislocation. The force used in reduction to be
applied at as great a distance as possible from the seat of the displacement.
Of nerves (ligaments?), those which are in motion and in humidity
(flabby?) are of a yielding nature; those that are not, less so. In
every dislocation the most speedy reduction is best. Reduction not
to be made while the patient is in a febrile state, nor on the fourth
or fifth day; and least of all, in those of the elbow, and all cases
which induce torpor; the soonest the best, provided the inflammatory
stage be avoided. Parts torn asunder, whether nerves, or cartilages,
or epiphyses, or parts separated at symphyses, cannot possibly be
restored to their former state; but callus is quickly formed in most
cases, yet the use of the limb is preserved. Of luxations, those nearest
the extremities are least dangerous. Those joints which are most easily
dislocated are the least subject to inflammation. Those which have
been least inflamed, and have not been subjected to after-treatment,
are most liable to be dislocated anew. Extension should be made in
the position most calculated to enable the one bone to clear the extremity
of the other, attention being paid to configuration and place. Adjustment
to be made in the direction of the displacement; to push the displaced
limb straight backward and sideways. Parts suddenly drawn aside are
to be suddenly drawn back by a rotatory motion. Articulations which
have been oftenest dislocated are the most easily reduced; the cause
is the conformation of the nerves (ligaments?) or of the bones; of
the ligaments that they are long and yielding; and of the bones, the
shallowness of the articular cavity, and roundness of the head [of
the bone that enters it]. Usage, by its friction, forms a new socket.
The cause-the disposition, and habit, and age. A part somewhat mucous
is not subject to inflammation.

The Genuine Works of Hippocrates. Hippocrates. Charles Darwin Adams. New York. Dover. 1868.

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